Violent Deaths: Just the Facts

Each year some 50,000 Americans die violent deaths, almost as many as were killed during the entire Vietnam War. In trying to reduce the toll, policymakers lack an essential tool: information.

Things we don’t know about violent deaths include:

• Where the deaths take place (schools? businesses? homes?)
• Which weapons are used (what is the weapon of choice for suicide? for gang warfare? are police “outgunned”)
• How do kids who kill themselves with a gun get the weapon?
• What proportion of homicides involve the use of an “assault weapon” and is that changing now that the federal assault weapon law has changed?
• What proportion of youth suicide victims were taking an antidepressant at the time they took their life?

State and local agencies have some information, but it’s fragmented — limited to isolated studies or databases covering one element. For example, death certificates have information on homicide victims, but not suspects. Information collected in one place is generally inaccessible in other places, making it impossible for local leaders to share information and solutions.

In December 2004 the National Academy of Sciences released a report entitled “Firearms and Violence,” which singled out the inadequacy of data as a critical barrier that makes it impossible to draw strong conclusions about the effects of various measures to prevent and control violence from firearms, which account for the majority of violent deaths.

Comprehensive information: The automobile model

A comprehensive national reporting system is essential to enable policymakers to understand patterns of violence, to develop policies to do something about violence, and to evaluate those policies.

Such a system already exists for automobile fatalities. For every fatal traffic accident in the United States, the Fatality Analysis Reporting System (FARS) compiles information on the make and year of the vehicle, the weather, the condition of the road and the driver, the use of seatbelts and airbags, posted speed limits, and much more. This information allows researchers to identify such threats as dangerous intersections, faulty SUV tires, and airbags injuring small children. It enables engineers to understand what contributes to fatal accidents and to make cars, highways and road signs safer. And it helps government officials create and enforce policies to protect pedestrians and drivers. It’s worked: even as the number of cars on the road increased, the number of car deaths per mile driven has declined, in part because policymakers had the information to act and to evaluate how specific actions could work.

The National Violent Death Reporting System

The beginnings of a similar system for reporting violent death are already in place. The Centers for Disease Control and Prevention established a National Violent Death Reporting System (NVDRS) in 2002 to track homicides, suicides and violent deaths of undetermined cause. Congress provided $1.5 million to begin implementing NVDRS in six states in 2002; it is now funding development of databases in 17 states. As the CDC explained in a recent issue of Morbidity and Mortality Weekly Report, “Analyzing data on the circumstances associated with violent deaths should provide a better understanding of personal and social risk factors for violence and help identify potential prevention opportunities.”

The National Violent Death Reporting System is an important initiative. But it needs full funding, and cooperation from state and local jurisdictions across the country, to reach its full potential.

How better data saves lives

A prototype for the national system already exists in the National Violent Injury Statistics System. Since 1999 NVISS has worked with sites in 11 states and metropolitan areas to collect information on violent injuries from death certificates, coroner and medical examiner reports, crime reports, and crime laboratories.

NVISS information demonstrates how understanding the facts can help prevent tragedy:

Crime: In San Francisco, data showed that nearly one-quarter of victims and suspects involved in firearm-related fatalities lived in other Bay Area counties. As a result, local health officials have initiated outreach efforts that cross geographic boundaries.

Suicide: Studies conducted by the Medical College of Wisconsin show that suicides in the state outnumbered homicides by 3 to 1 and hospital charges for self-inflicted injuries totaled nearly $32 million. These facts underscored the potential for saving lives by investing in suicide prevention.

Child abuse and domestic violence: In Florida, medical examiner and police records revealed that over a five-year period, half of the firearm deaths involving children age 10 or younger were the result of intimate partner violence directed at the mother. This information offers valuable insight to both domestic violence and child abuse prevention groups.

What are the next steps?

• Fund the National Violent Death Reporting System in all 50 states. Cost: an estimated $20 million annually.
• Ensure consistent, comparable data collected across sites, using uniform definitions and quality control checks.
• Link data from disparate sources into one uniform database and forwarded to the national level.
• Create confidentiality protections to prohibit making individual-level information available in a way that identifies cases.
• Ensure that information is easily accessible to researchers, policymakers and the public.